Long-term follow-up of cancer risk in patients treated with short-term cyclosporine

Cyclosporine increases the risk of skin and lymphoid tissue malignancies in organ transplant patients. A similar increase has been shown among psoriasis patients, but no data exist on the carcinogenic risk of cyclosporine monotherapy in skin diseases. We conducted a retrospective cohort study of 272 patients, all of whom had received at least one month of cyclosporine treatment. The cancer information on these patients was obtained from the Finnish Cancer Registry. The median follow-up time was 10.9 years and the median treatment time with cyclosporine was 8 months. We did not detect any increase in the risk of skin malignancies or lymphoma. The overall risk of cancer was almost identical to that expected in the general population (standardized incidence ratios (SIR) = 1.31, 95% confidence interval (CI) = 0.70-2.23). This study shows that short-term cyclosporine treatment is probably not related to subsequent malignancy. Since the CI of the SIR estimate was rather wide, larger studies are needed in the future.     

A follow-up study of occupational skin disease in Western Australia

From a total of 993 previously reported cases of occupational skin disease (OSD), 954 (96%) were contacted and 711 (75%) examined, The review time (i.e., period from original diagnosis of OSD until review] varied from u minimum of 6 months to a maximum of over 8 years. Over 60% of cases were reviewed more than 2 years after the original diagnosis was made. More than 50% were still suffering from OSD or consequences related thereto. Clearance was less likely in those who remained in their original, or similar, occupational environment. However, of those who changed their job due to OSD. Many suffered aggravation of the dermatitis from factors in the new work environment. Over 10% of cases had evolved into a persistent post occupational dermatitis without obvious cause. This condition is responsible for considerable impairment and is of medicolegal importance due lo confusion as to its relationship to the original occupational factors.     

皮肤恶性肿瘤microRNA的研究进展

MicroRNA(miRNA)分子广泛参与调控机体细胞的增生、分化、代谢、凋亡等生理病理活动,通过各种复杂的机制调控肿瘤的发生和发展。近来研究发现,皮肤肿瘤中存在miRNA的异常表达,提示miRNA亦参与皮肤肿瘤的发生和发展过程,同时人们对二者的关系及其具体机制进行了研究。该文对基底细胞癌(basal cell carcinoma,BCC)、鳞状细胞癌(squamous cell carcinoma,SCC)、恶性黑素瘤(malignant melanoma,MM)miRNA研究进展作一概述。     

Long-term repetitive sodium lauryl sulfate-induced irritation of the skin: an in vivo study

Skin may adapt to topical irritants through accommodation. This study focuses on long-term exposure to irritants and attempts to demonstrate accommodation. Sodium lauryl sulfate (SLS) induced irritant contact dermatitis at 3 concentrations (0.025% to 0.075%). Distilled water, acetone and an empty chamber served as controls. Experimental compounds were applied to forearms of 7 healthy volunteers for 24 hr before replacing by a fresh chamber for 6 non-consecutive weeks over 103 days. Possible accommodation was quantified by visual scoring (erythema and dryness) and by bioengineering parameters: transepidermal water loss (TEWL), capacitance, chromametry and laser Doppler flowmetry (LDF). Significant erythema, dryness, elevated TEWL, skin colour reflectance and LDF values occurred during the exposure periods. Upon repeat exposure, an immediate and augmented response in erythema, TEWL, skin colour reflectance and LDF developed. However, irritant skin changes were not sustained. Irritation parameters return to baseline after cessation of exposure. There was no evidence of sustained irritation or accommodation after the last exposure. Study findings do not document sustained accommodation or adaptive hyposensitivity after long-term repetitive irritant exposure under these test conditions. Alternative models should be developed to prove or disprove the accommodation hypothesis.     

Long-term follow-up of dermatitis herpetiformis in children

Dermatitis herpetiformis was diagnosed in seventy-six children by its clinical features and by detection of granular IgA deposits in the papillary dermis of perilesional skin. Enteric alterations demonstrated by measurement of D-xylose absorption and by small intestinal biopsies were detected in over 90% of all patients. A complete follow-up was obtained for all children who were followed for 3 to 10 years. Treatment with a gluten-free diet alone led to a reversal of the intestinal abnormality in 100% of our children and to the disappearance of cutaneous lesions in 82% of reported cases. This suggests that a complete remission of symptoms can be obtained with a gluten-free diet alone. Dapsone alone is effective therapy for the rash but does not affect the intestinal alterations. Furthermore, the lack of side effects to dietetic therapy for a long period of time makes the diet the treatment of choice in this disease.     

PUVA and cancer risk: the Swedish follow-up study

There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) for treatment of skin disorders. Many authors have found an increased risk for cutaneous squamous cell carcinoma (SCC). Except in anecdotal reports, malignant melanoma had not been observed in patients treated with PUVA until recently. In the U.S.A., a 16-centre prospective study of 1380 patients showed for the first time that there might also be an increased risk for malignant melanoma in patients treated with high cumulative dosages of PUVA. We have therefore followed up the Swedish PUVA cohort until 1994. This cohort had previously been followed up until 1985. Information from 4799 Swedish patients (2343 men, 2456 women) who had received PUVA between 1974 and 1985 was linked to the compulsory Swedish Cancer Registry in order to identify individuals with cancer. The average follow-up period was 15.9 years for men and 16.2 for women. We did not find any increased risk for malignant melanoma in our total cohort of 4799 patients treated with PUVA or in a subcohort comprising 1867 patients followed for 15-21 years. For cutaneous SCC there was an increase in the risk: the relative risk was 5.6 (95% confidence interval, CI 4. 4-7.1) for men and 3.6 (95% CI 2.1-5.8) for women. Significant (P < 0.05) increases were also found in the incidence of respiratory cancer in men and women and of kidney cancer in women. In conclusion, we did not find any increased risk for malignant melanoma in our patients treated with high doses of PUVA and followed up for a long time. We confirm previous reports of an increase in the incidence of cutaneous SCC in patients treated with PUVA, and recommend that patients should be carefully selected for PUVA and rigorously followed up.     

Long-term follow-up of photochemotherapy in pityriasis lichenoides

Five patients with a histopathologically confirmed diagnosis of pityriasis lichenoides were treated with PUVA or irradiated with a light source emitting UVB and UVA, without prior intake of psoralens. All patients showed a good response to treatment. Long-term follow up showed that patients remained free of lesions during a period of 20 to 36 months; 3 patients had a recurrence of the disease, though less extensive than before, after 25, 23, and 23 months, respectively.     

Objective follow-up of atypical melanocytic skin lesions: a retrospective study

Various authors have suggested that information from longitudinal observation (follow-up) of dynamic changes in atypical melanocytic pigmented skin lesions (MPSL) could enable identification of early malignant melanoma escaping initial observation due to an absence of specific clinical and dermoscopic features. The aim of our retrospective study was to determine the existence of numerical variables regarding changes in MPSL that could be useful to differentiate early melanomas and atypical nevi. The study was carried out in two Italian dermatology Centres. Digital dermoscopy analyzers (DB-Mips System) were used to evaluate dermoscopic images of 94 equivocal pigmented skin lesions under observation for 6–12 months and then excised because of changes across time (29 melanomas and 65 nevi). The analyzer evaluates 49 parameters grouped into four categories: geometries, colours, textures and islands of colour. The ROC curve designed on the 49 digital dermoscopy analysis parameters showed good accuracy. At sensitivity (SE) = specificity (SP), it correctly classified 89.3% of cases. When objective pigmented skin lesion parameters were considered together with their objective changes over 6–12 months, a decisive increase in discrimination capacity was obtained. At SE = SP accuracy was 96.3%. Analysis of the parameters of our model and statistical analysis enabled us to interpret/identify the most significant factors of modification and differentiation of lesions, providing quantitative insights into the diagnosis of equivocal MPSL and demonstrating the utility of objective/numerical follow-up.     

Long-term follow-up of lichen planus.

Several large series of patients with lichen planus were reported some 30 years ago but no recent large surveys have been published. In this study, detailed enquiry was made into the natural history of the disease in 214 patients followed up 8 to 12 years after presentation to the Dermatology Department. The key findings from this study showed that the mean age of onset of lichen planus in males was significantly lower than in females (40.3 years in males compared with 46.4 years in females, p less than 0.05). The main eruption of lichen planus cleared within one year in 68% of the patients but we found a higher recurrence rate than in previous series at 49%. Many patients suffered from persistent brown staining many years after the rash had cleared.     

Long-term follow-up study of changes in lipid peroxide levels and the activity of superoxide dismutase,catalase and glutathione peroxidase in mouse skin after acute and chronic UV irradiation

Lipid peroxide levels, the activities of superoxide dismutase (SOD), catalase and glutathione peroxidase (GSH-Px), and the development of tanning in the skin of C57 BL/6 mice were assessed for long periods, from very early to late stages, after acute or chronic UVB irradiation. Acute UVB irradiation produced an increase in lipid peroxide levels that peaked 18 h after irradiation, after which the levels declined to a minimum 2–3 days after irradiation and then gradually rose to baseline. Chronic irradiation caused the lipid peroxide level to fall to a minimum at 0.5–1.0 weeks, after which it gradually returned to baseline by the third week. SOD and GSH-Px activities decreased sharply after acute irradiation, reaching a minimum 18 h after irradiation. Following chronic irradiation, these enzyme levels peaked after 0.5 weeks, and thereafter declined gradually to the original levels 3 weeks after irradiation. In contrast, catalase activity did not change significantly. Tanning began to increase at 1.5 weeks after irradiation, with an accelerated rate of increase from the third week. Although UVB has been reported only to decrease or impair reactive oxygen species (ROS) scavenging enzyme activity, we postulate the following from our results: (1) the increase in lipid peroxide levels observed after irradiation was due to UVB-induced ROS; (2) the parallel decrease in enzyme activities may have been due to inactivation by ROS; (3) the decrease in lipid peroxide levels following the peak at 18-h resulted from the scavenging effect of increasing SOD and GSH-Px activities, and (4) the increase in these two enzyme activities was the result of their induction by the increased lipid peroxides or ROS. In addition, these results seem to suggest a possible correlation of melanogenesis with UVB-induced ROS.     

Long-term follow-up outcomes of laser-treated port wine stain patients: A double-blinded retrospective study

Background

Port wine stains (PWS) can be effectively treated with lasers. However, complete clearance is rarely observed, and data from long-term studies are limited. The study aimed to evaluate the efficacy and complications of long-term laser treatment in patients with PWS.

Methods

We performed a 25-year double-blinded retrospective chart review of patients diagnosed with PWS who underwent laser treatment at Ramathibodi Hospital, Thailand, between June 1995 and June 2021. The scores for improvement and color were independently evaluated by two dermatologists.

Results

A total of 129 patients were included. Most patients were male (70.54%). A total of 4141 laser treatment sessions were reviewed, with a median of 49 (interquartile range, 27–66) sessions per patient. A total of 1070 photographic records were reviewed. Overall, 53% of the patients achieved statistically significant (50%) improvement, after six treatment sessions. However, none of these patients achieved complete clearance. Due to the nonuniform treatments, we could not evaluate the efficacy of each laser type. However, this study illustrates the outcomes of a real-world setting in which various laser types were selected specifically for each patient to obtain the best result.

Conclusions

Vascular lasers are a promising treatment for PWS. Although laser treatment is applicable to most patients, multiple treatment sessions are required to achieve excellent results.     

户外运动与皮肤癌相关性研究进展

本文论述了紫外线的照射剂量与皮肤癌发病的关系及紫外线的防护措施,以期为户外运动人群采取紫外线防护措施提供科学的理论依据。     

Nonmelanoma skin cancer mortality. A population-based study

To estimate the magnitude of nonmelanoma skin cancer mortality and describe its parameters, we reviewed the medical records of all deaths certified as due to this cause among Rhode Island residents from 1979 through 1987. After excluding acquired immunodeficiency syndrome-associated Kaposi's sarcoma, we confirmed that nonmelanoma skin cancer was the cause of death for 51 individuals, a quarter of the number of melanoma deaths reported. The age-adjusted nonmelanoma skin cancer mortality rate was 0.44/10(5) per year. Fifty-nine percent were due to squamous cell carcinoma, and 20% were due to basal cell carcinoma. Most appeared actinically induced. Among deaths from squamous cell carcinoma, the mean age was 73 years. At least 80% of the squamous cell carcinomas metastasized, and 47% arose on the ear. None appeared due to refusal of treatment. Among deaths from basal cell carcinoma, the mean age was 85 years, and refusal of surgical intervention was documented in 40%. Study of nonmelanoma skin cancer mortality provides for estimation of the magnitude of this problem, complements other studies of prognosis, and helps guide prevention, early detection, and treatment.